Instrument for electrosurgical resection



Nov. 8 w49 A. WILLINSKY INSTRUMENT FOR ELECTROSURGICAL RESECTION 2 Sheets-Sheet 2 Filed Sept. 26, 1945 INVENTOR.

ffQR/YEY Patented Nov. 8, 1949 INSTRUMENT FOR ELECTROSURGICAL RESECTION j Abram I. Willinsky, Toronto, Ontario, Canada,

assignor to American Cystoscope Makers, Inc., New York, N. Y., a corporation of New York Application September 26, 1945, Serial No. .618,683

' V13 claims.` (c1. 12s-303.14)

This invention relates to a surgical instrument, and in one of its more specific aspects to such an instrument capable of readily removing protrusions, tissue growths, and the like, by resection with the aid of a high frequency electric current.

The instrumentl of this invention is particularly well suited for use in resecting tumorous growths or other masses of body tissue in body passages and cavities. For example, the present invention may be readily employed for the resection of protrusions in the urethra and bladder neck, and for the excision of undesirable growths on the prostate gland and other internal organs.

As will be apparent to persons skilled in the art from the detailed description that follows, the instrument maybe inserted in a body passage or cavity to the region of the protrusion or the like which is to be removed, whereupon the protrusion or the like may be resected by a high frequency j cutting electrode means Linder conditions of illuminated vision. One of the features of the invention resides in arranging the endoscopic sheath, the telescope, and the cutting electrode means in such a manner that they may be rotated as a unit with respect to a supporting structure which preferably includes a pistol type grip. This permits of ready angular adjustment of the unit with respect to the supporting means, thereby veliminating awkwardness and strain on the part of the surgeon in operating the instrument.

The benefits derived by employing the instrument of this invention will be readily apparent when it is realized that in present-day resectoscopes, the endoscopic tube, telescope, and cutting electrode means are all mounted in fixed non-v `A rotatable relation with respect to their supporting structure. When the surgeon desires to remove tissue growth from sections to the right or to the left of the original cut or from sections above the intial cut, it is necessary that he impart a rotary movement to the entire conventional instrument with his hand. This results in strain and awkward movement on the part of the surgeon, as his arm and hand employed in operating the instrument must necessarily be twisted intollf mined position while the endoscopic sheath, telescope and/or cutting electrode means may be independently rotated withrespect to the supporting means to the. desired cutting position. To this end the instrument comprises anendoscopic sheath provided with a lateral fenestra at its forward end and having an illuminated telescope and cutting electrode means removably disposed therein. These elements maybe considered as constituting vairst unit. A second unit includes a support, preferably in the nature of a pistol grip, and a plurality of spaced bearing members carried by the pistol grip. At least one of the bearing members is rigidly secured to the pistol grip, while anotherl thereof is slidable Valong the pistol grip. Secured to the first unit and rotatably engaging the bearing members of the second unit is a means whereby rotation may be imparted to the first unit with respect to the second unit. By this construction the first unit may be adjustedto desired angular position with respect to the second unit, thereby facilitating manipulation of the instrument as a whole under operating conditions. The instrument includes appropriate means for supplying illumination to the telescope and devices for transmitting a high frequency electric current to the cutting electrode means.

The cutting electrode means is so arranged that it may be moved longitudinally with respect to the endoscopic tube and the pistol grip through the medium of suitable means coacting therewith and with the slidable bearing. As will be apparent from the detailed description further along and from the annexed drawings, the cutting electrode means is movable longitudinally With Y respect to the endoscopic tube independently of the rotation of the rst unit with respect to the second unit.

lIt is an important object of this invention to provide an improved surgical instrument for readily resecting a protrusion or the like with the aid of a high frequency electric current.

This invention has for another objectthe provision of an instrument of the character described having certain elements adjustable angularly with respect to a supporting means whereby manipulation and operation of the instrument are greatly facilitated.

It is another object of the invention to provide an electrosurgical instrument wherein an endoscopic sheath, a telescope and/or a cutting electrode means are rotatable as a unit with respect to a supporting structure, and wherein the cutting electrode means is independently movable ii iongitudinally with respect to the endoscopic tubo.

A further object of the invention is the pron vision of an electrosurgical instrument of the character indicated that is relatively simple and compact in design, reasonable in initial and up keep costs, and capable of performing its intended functions in an effective and trouble-free manner.

These objects, as well as other objects, to gether with the advantages obtainable by the practice of this invention, will be readily under-Y stood by persons skilled in the art upon reference to the following detailed description, taken in conjunction with the attached drawings, which respectively describe and illustrate a preferred embodiment of the invention.

In the drawings:

Figure 1 is a side elevational view of an instrument embodying the devices of the invention in one relative position, partly in central vertical cross section and with parts broken away for better illustration.;

Figure 21 is a cross-sectional view taken along line 2--2 of Figure. 1;

Figure 3 is a side elevational view of the instruyment withA the devices in another relative position.;I

Figure 4 is enlarged cross-sectional view takenalong line 4-4 of Figure 1;

Figure 5* isv an enlargedy cross-sectional view taken` along line- 5-5 of Figure 1;

Figurey 6 isI an enlarged vcross-sectional view taken alongA staggered linev 6--6 of Figure 1;

Figure 7` is an enlarged cross-sectional view takenalong line |-'|v of-Figure 1;

Figure 8 is an enlarged cross-sectional view taken along staggered line 8 8 of Figure 1; and Figure 9 is an enlarged' cross-sectional view taken along staggered line 9---9l of Figure 3.

Referring now to the drawings wherein like reference characters'- denote corresponding parts throughout theseveral views, and more particularly tol FiguresA 1 and 2, there is shown an endoscopic tube I8 provided at its forwardl end with a lateral fenestra and provided with external threads at itsrearward end: forengagement with corresponding internal threads in a flared collar |21'. An inlet conduitv I3, secured to collar I2, is adapted to introduce an irrigating liquid in-tothe interior of' endoscopic tube- I0', the irrigating fluid being withdrawn from the endoscopic tube through a discharge conduit I4, which isequipped with a control valve I5 having an operating lever I6. Collar I2 is formed with a forwardly and inwardly tapered recess that engages a connector device |18-, having a frusto-conical forward portion, in a fluid-tight manner. As is best shown in Figure 5, device I 8^ is provided with a pair of separate parallel openings I9 and 20 for the reception of a telescope 2| and a cutting electrode means 22, respectively, that will be described in greater detail further along herein.

Both the telescope and the cutting electrode means form adequate seals with the corresponding openings indevice I8, and the cutting electrode means is additionally capable, of being readily moved longitudinallyv through its opening 28.

Affixed todevice I8A in any desired manner is a longitudinally bi'furcatedv arm 23 (Figure 3), adapted to receive a post 24 that projects upwardly ofi collar l2; Post 2li` carries a locking attachment 25 for effecting coupling engagement between the post and arm 23. Device I8 is tapped,

as indicated in Figure 2; to-threadedly engage the rearward end portion of a member 26 that is preferablycoaxial with endoscopic tube It, and

that is formed with a pair of elongated parallel longitudinal arcuate grooves 21 and 28 (Figure 4), which respectively accommodate forward portions of telescope 2| and cutting electrode means 22.

Endoscopic tube I0, telescope 2|, and cutting electrode means 22 are adapted to be mounted on and rotated as a unit with respect to a second unit comprising a support, generally denoted by numeral 38, that will now be described. Support 38 includes a handle 3|, preferably of the pistol grip type and composed of a suitable electrical insulating material. As is shown in Figure 1, pistol grip 3| is notched or recessed at 32. Secured to pistolgrip 3| by rivets 33 is a pair of spaced parallel plates 34-, each having an integral extension 35. A bracket 38, having a pair of spaced laterally projecting arms 39 (Figures 3 and 5), is arranged across the free ends of extensions 35 and is secured thereto by screws 40. An externally threaded hollow plug 45| extends through bracket 38 and serves as the bearing for' the forwardv end of a rod 42, which has its rearward end' journalled ina blind bore'formed in a second threaded plug 43 that is carried by pistol grip 3| (Figure 1) This invention includes a mechanism 4,5, that is reciprocable along rod 42 and extensions 35 and that is best shown in Figures. 1, 2, 3 and '7. Mechanism i5 includes a main body portion 46 that is anged at the toptof-ride along the upperA surfaces of extensions S5 and that` is bored at 41 to freely receive rod 42. Depending from body portion 46 is an actuating trigger or curved finger lever 48. Integral with body portion46 and extending rearwardly therefrom, is a yoke 49 that carries a roller 55, rotatable about a pin 5| and along the under surface of each extension 35. Coaxial with rod 42 is a compression spring 52 that bears at its opposite ends againstbody portion 46 and plug 43 to normally and yieldingly maintain mechanism 45 in protracted' position, as is indicated in full lines in Figures 1 and 3. Mechanism 45 may be retracted against the action of compression spring 52 to the position indicatedV by the dot-anddash lines in FigureV 1 by merely engaging trigger 48 and exerting a force toward the right thereon. Integral with bracket 38 is an upstanding first bearing member orV ring 55. The rearward end portionof device I8.` is of reduced diameter and is rotatably accommodated inbearing member 55. A backing plate `56, having.V a central opening 51 through which telescope 2|'l and. cutting electrode means 22A are adaptedtopass, is affixed to the rear end face of device I8 by means of screws 58. Backing plate 56 prevents accidental disengagement of device I8 frombearing member 55.

Extending upwardly from mechanism 45 is a second bearing member inthe nature of a saddle in whichg-aflangedY disc'lisV rotatably mounted. A plateV 621 ispositionedimmediately adjacent the forward' end face of disc 6I and has a split clamping plate 63 secured thereto by screws 641 (Figure 6). Clamping plate 64 carries a knurled clamping. screw- 65. Immediately adjacent the rearward. end'face of disc 6| is a hollow block 66, composed of a suitable insulating material, such; asl hard'` rubber, and having an electrically conductive ring 6"!! and an. integral electrical terminal nippleA S'B imbedded therein. A plate 69 is attached tothe; rear end face of'block 66 by means ofA screws 10.. A screw 1I in turn joins plate62`,v disc 6| andblock- {i5-into a unitary assembly, whichisrotata'ble inA bearing member Illand' whichis reciprocabl'e with respect to` the endoscopic tube ||J`1andf supportf 30 in response to actuation of mechanism 45. borne in mindA that clamping plate 63, plate 62,

It shmnmbe disc 6|, block 66 and plate 69 are readily reciprocable as a unit with respect to telescope 2|. On the other hand, cutting electrode means 22 is clamped to plate 63 through the action of clamping screw 65 and is hence reciprocable with respect to endoscopic tube Ill upon actuation of mechanism 45.

Attached to plates 34 by screws 12V is a combined bracket andcover plate 13, which carries a third bearing member or ring 14, It may be f well to point out at this time that bearing members 55, 6|] and 14 are coaxial under various operating conditions. A flanged disc is rotatably mounted in bearing `member 14 and has a backing plate 16 amxed thereto by a series of `screws 11 to prevent accidental disengagement.

A split clamping plate 18, similar to earlier referred to clamping plate 63, is attached to the rear end face of disc 15 by means of screws 19 and has a knurled clamping screw 80, whereby telescope 2| may be readily and no-n-rotatably secured to clamping plate 18 and, therefore, to disc 15. A pair of parallel guide rails 8| extend through various elements as shown in Figure 2, and are secured at their opposite ends to backing plates 56 and 16, respectively. By'virtue of the construction illustrated and described, endoscopic tube |0, telescope 2| and cutting electrode means 22 may be rotated as a unit about the coincident axes of bearing members 55, 6d` and 14. Also, as set forth above, cutting electrode means 22 is separately reciprocable by simply actuating mechanism 45.

Telescope 2| includes a main tubular body 82 of relatively small diameter adapted to be inserted through the respective assemblies rotatably mounted in third bearing member 14, second bearing member 60, and rst bearing member 55 in the order named, and thence through opening |9 in connector device I8 and in registration with arcuate groove 21 in member 26 until it assumes Y the position shown in Figure 1. An electric lamp 83 is attached to the forward end of tubular body 82 to provide illumination through fenestra when the instrument is assembled. At the rearward end of tubular bodi7 82 is an eye piece 84. The telescope lens system (not shown) may be of any suitable type, such as, for example, the lens device 85, as is shown in Figures 1 and 3.. As

was indicated above, telescope 2| is locked to the assembly rotatably mounted in third bearingr member 14 through the coaction of clamping plate 18 and clamping screw 8U.

Referring next to cutting electrode means 22,

I, the same includes an electrically lconductive rodv 90 concentrically disposed within and insulated from a tubular shaft-like element 9|, having its rearward portion clamped in the assembly rotatably mounted in second bearing member 60.

Tubular element 9| is movable longitudinally through connector device |8 and reposes inv arcuate groove 28. The rearward end portion of rod ,90 extends beyond tubular element 9| and is in electrical contact with conductive ring 61. The forward end portion of rod 9|! also extends beyond tubular element 9| and is split to obtain a;

.pair of divergent arched arms `93,:thatlcar1y, a

high frequency U-shaped cutting elementll.

The mode of operation .ofthe instrument for the resection of a mass of tissue ina bodycavity will now be briefly described. Locking attachment 25 is disengaged from bifurcated arm 23 and the devices within endoscopic tube |0 areremoved therefrom. A suitable obturator (not shown) is then'placed in the endoscopic tube .and the tube is inserted in the body cavity in the usual manner until fenestra arrives at the approximate location of the tissue growth. Body fluids 'are withdrawn through endoscopic tube |0 and 4discharge conduit |4, as allowed. by` valve I5, and

the obturator is removed. The various devices are then assembled in the relative positions shown in Figure 1, electrical connection with lamp 83 being made through terminal device 85. Nipple 68 is then connected with one terminal'of an appropriate source of high frequency electric current, the patient being grounded or suitably connected with the other terminal of the high frequency current source. An lirrigating vliquid may be introduced into the body cavity through inlet conduit |3 and the interior of endoscopic tube |0. The irrigating liquid is withdrawn by way of endoscopic tube I0 and discharge conduit |4. The surgeon is now ready to remove the tissue growth. I-Ie grasps vpistol grip 3|" in one hand, placing the index finger of that hand on trigger 4'8, and sights through telescope eye piece 84 to locate the exact region where it is desired to carry out the cutting operation. The tissue growth that is to be cut is accommodated within fenestra and the high frequency electric circuit is completed. The surgeon exerts a pull on trigger 4'8 with his index finger, thereby moving body portion 46, bearing member 68, the assembly rotatably supported in bearing member 60, and cutting electrode means 22 toward the right, as viewed in Figure 1, and to the position indicated by the dot-and-dash lines, whereby a portionoi the Vtissue growth is resected by cutting element 94. Upon release of trigger 48, mechanism and the devices operated thereby are protracted to the full line position (Figure 1) due Vto the action of compression spring 52. I-f it is desired to remove tissue to the right or left of the original cut, thek surgeon merely imparts suflicient relative rotational movement to the endoscopic tube, the telescope, and the cutting electrode means as a unit with respect to pistol grip 3|, for example, by manipulating knurled disc 15 with the fingers of one hand while firmly grasping the pistol grip with his other hand, and then actuates trigger 48, as will be obvious from an inspection of the drawings.

From the foregoing, it is believed that the construction, operation and advantages of my present invention will be readily comprehended by persons skilled in the art. It is to be clearly understood, however, that various changes in the apparatus may be resorted to without departing fromv the spirit of the invention, as defined by the appended claims.

I claim:

1. In an instrument of the character described, a support, bearing means carried by the support, an endoscopic tube, a telescope in the tube and cutting electrode means in the tube, said tube,

telescope and electrode means being united and rotatably, mounted in the bearing means for simultaneous rotation with respect to the support, and means for effecting reciprocable movedevice, and means for imparting rotation to the device for simultaneously eiTecting rotation of the endoscopic tube, the telescope and the electrode means with respect to the handle.

13. A surgical instrument comprising a handle, a device for carrying instrumentalities rotatably and reciprocably mounted upon the handle, an endoscopic twbe mounted upon the handle and rotatable with the device, a telescope Within the endoscopic tube and rotatable with the device, cutting electrode means reciprocable within the endoscopic tube, said electrode means being rotatable and reciprocable with the device, means for imparting rotation to the device for simultaneously effecting rotation of the endoscopic tube, the telescope and the electrode means with respect to the handle, and means carried by the handle to impart reciprocation to the device and the electrode means with respect to the handle. ABRAM I. VVILLINSKY.

REFERENCES CITED The following references are of record in the le of this patent:

UNITED STATES PATENTS 

